Vocal fold cysts usually occur in patients who misuse or overuse their voice, such as professional singers or speakers. Other possible causes are scarred vocal folds, growths on vocal folds, or even reflux disease. Benign lesions may result in which a fluid-filled sac forms most often near the mid-portion of the vocal fold, also known as the Reinke space. This is the area that is exposed to the most stress during the production of sound. These cysts are only important because of effects on the patient’s voice. They are not cancerous or precancerous.
Types of Cysts
Two types of cysts are found in this area, epidermoid cysts and mucus retention cysts. Epidermoid cysts accumulate keratin or contain epithelium and may be the result of a duct obstruction. Often translucent, mucus retention cysts are lined with columnar epithelium and may occur spontaneously or as the result of improper vocal hygiene.
Symptoms of Vocal Fold Cysts
The primary symptom of a vocal fold cyst is hoarseness due to the vocal fold closing in an unnatural fashion or vibration irregularities, both of which result from the location and bulk of the cyst in the vocal fold. Hoarseness may be accompanied by a sensation that the throat needs to be cleared frequently. The patient may feel that there is a foreign body lodged in the vocal region. Other symptoms include soreness, pain, fatigue, and increased effort when using the voice. Breaking at a certain pitch or an abrupt loss of the voice is commonly reported in singers. A vocal fold cyst may not affect the speaking voice but cause marked problems with the singing voice.
Diagnosis of Vocal Fold Cysts
Diagnosis of this condition requires minimizing inflammation of the vocal region so that lesions may be seen. Patients may be prescribed medication or placed on modified voice use to reduce inflammation. High-dose corticosteroid treatment is often used to relieve swelling while leaving the cyst unaffected.
Treatment of Vocal Fold Cysts
The first treatment prescribed is voice therapy, but surgery may be needed if therapy is ineffective. It is rare that a vocal fold cyst resolves on its own. If the cyst has only been present for a short time, the blockage leading to fluid accumulation may resolve and the cyst may drain. These circumstances are very unusual.
Vocal Fold Cyst Removal
Recurrence may occur if removal is incomplete, therefore removing the cyst intact is most efficient. The mucosa must be manipulated to cover the area of the lesion to minimize scaring. The cyst is most often very fragile and can burst when detached from surround tissues. Surgery involves insertion of a laryngoscope into the mouth of the anesthetized patient so that vocal folds are exposed. The procedure is very delicate and technically challenging. It requires magnification of the vocal structures with the use of a microscope to enhance the view of the vocal fold. The surface of the vocal fold is then cut using micro-instruments that are specialized for this type of procedure. The cyst is then carefully removed and the area is covered by the mucosa. Voice rest and therapy are vital following the surgery.